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Predictive Factors and Long-Term Outcome of Respiratory Failure after Guillain-Barré Syndrome

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ABSTRACT

Objective

To analyze predictive factors and long-term recovery in patients with Guillain-Barré syndrome (GBS) who are in need of mechanical ventilation.

Methods

In this 15-year retrospective study, 77 adult patients were identified with GBS. A comparison was made between the clinical data from patients who required mechanical ventilation and those who did not. Furthermore, the therapeutic outcomes of those 25 patients in need of mechanical ventilation during hospitalization at 1 year were determined using a modified Barthel index. A score below 12 was defined as a poor outcome, whereas a score of 12 or more was good.

Results

The study revealed 32% of patients (25/77) in need of respiratory support during hospitalization. At a follow-up of 1 year among the 25 ventilated patients, 7 patients (28%) had normal or minor signs and symptoms, 6 had unassisted gait, 3 had assisted gait, 6 were wheelchair- or bed-bound, and 3 died. The cause of death was septicemia with septic shock in all 3 cases. Factors that predict respiratory failure in the study GBS patients were disability grade on admission and areflexia. Those ventilated patients who had low maximal inspiratory pressure (PImax) (< 14.5 cmH2O) and maximal expiratory pressure (PEmax) (< 13.5 cmH2O) values at the time of intubation and the presence of complications after mechanical ventilation inevitably had worse outcomes than those who had not.

Conclusion

If low values of PImax and PEmax at intubation were detected, aggressive respiratory management, which might include tracheostomy to allow more efficient bronchial clearing, and prevention of complications caused by prolonged course of mechanical ventilation are essential to maximize the potential for survival.

Section snippets

Patients and Methods

We retrospectively reviewed the electrodiagnostic studies and medical records of 77 adult patients with GBS admitted to the Chang Gung Memorial Hospital in Kaohsiung between January 1987 and December 2001. This facility, the largest medical center in southern Taiwan, is a 2482-bed acute-care teaching hospital that provides both primary and tertiary referral care of patients. Among the 77 adult patients, 25 suffered from respiratory failure and were in need of respiratory support during the

Results

Of 77 patients with GBS, 25 (32%) required mechanical ventilation, including 15 male and 10 female patients with a mean age of 51.1 ± 22.2 years (range, 17–88 years). Among these 25 cases, an antecedent event was reported in 9 cases (36%). The following preceding events were found: upper respiratory infection (seven cases), herpes zoster infection (one case), and urinary tract infections (one case). The presenting clinical features on admission, in decreasing order of frequency, were pain or

Discussion

Guillain-Barré syndrome is the most common peripheral neuropathy causing respiratory failure.1 Mechanical ventilation has been reported to be administered to about 20% to 30% of patients in different series,2., 3. and it accounted for 32% (25/77) of our adult patients. Furthermore, fatality rates for GBS patients requiring mechanical ventilation for respiratory failure has been estimated to be around 15% to 30%,9., 10., 11., 12. although in our study, it accounted for 12% of the episodes.

It is

Conclusion

Contrary to the established belief that patients with GBS usually recover, several hospital-treated patients die or present residua even several months after the onset of symptoms. Factors that predict respiratory failure in our GBS patients were disability grade on admission and areflexia. Those patients who had low values of PImax and PEmax at the time of intubation and who had complications after mechanical ventilation inevitably had poor outcome. When patients have a low PImax (< 14.5 cmH2O)

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